Thursday, 30 July 2015

On the 6th July 2015, the Minister for Health Mark Drakeford published a Green Paper, "Our Health, Our Health Service, " with the purpose of stopping the rot or in the Green Paper's words:

"... is to promote discussion and gather views to help inform the potential for further legislation in the Fifth Assembly with regards to improving quality and governance in the NHS in Wales"

The Green Paper whilst not promoting quality as it claims to do will in fact reduce the regulatory regime and remove powers of inspection of health care settings from Community Health Councils. Paragraph 92 of the Green Paper states:

"... The role of CHCs may need to be refocused
towards some key functions, such as collectively representing the patient
voice and providing advocacy for people wishing to raise concerns about
care, while stepping back from activities which may be better carried out
by others, such as inspections and service change proposals. In addition,
the current model of one CHC for each health board area may no longer
be the best fit for a service which works increasingly across boundaries
and in partnership with other services. CHCs may need to change reflect
a more integrated service model. Whether and how CHCs should change
to fit the new integrated structure needs carefulconsideration "

The regulation regime for visits will if the above is agreed fall to the Health Inspectorate Wales, who are not slow in ensuring their rehabilitation (after Tawelfan) and are busily undermining and briefing against the Community Health Councils to strengthen their own position.There is however a vast difference in the capacity of Community Health Council's to carry out inspections of health care settings compared to the capacity of the poorly resourced and bureaucratic Health Inspectorate Wales. The difference between the two organisation is best exemplified by an email that the Chief Executive of the North Wales CHC, Geoff Ryall - Harvey sent to his members:

You will be aware that the NHS Green Paper proposes that CHCs should be stripped of their rights to enter and inspect NHS premises – a right we have held since 1974. I understand that this proposal is strongly supported by HIW who have been promoting their own “professionalism”, criticising the CHC’s lay focus and citing the Minister’s desire to do away with duplication in the inspection of the NHS.

Before accepting these arguments at face value, it would be useful to look at how things work in the real world. Let’s take, for example, Bryn Beryl Community Hospital;

When the CHC first visited Bryn Beryl using its BugWatch regime in the Summer of 2014, CHC members were appalled by the findings. I contacted the Director of Nursing and the Director of Infection Control & Preventionthat day. The hospital was closed and a range of measures including deep cleaning, staff training and support and extensive repairs to the fabric of the building were undertaken very rapidly.

CHC members visited Bryn Beryl again in November 2014 and also in February 2015 using our CareWatch methodology. We found the hospital much improved but still relatively poorly performing. We notified BCUHB accordingly and they undertook to address the issues raised.

When we visited in June of this year we found that the problems we identified in Summer 2014 were back again. CHC Officers contacted the Director of Nursing and the Director of Infection Control & Prevention and we went through a similar process of rapid rectification. The worrying thing is, of course, that matters in this isolated community hospital had deteriorated once again without BCUHB being aware of it.

Where were HIW in all of this?? The last time they visited Bryn Beryl was 2008. Seven years ago – 3 years before the creation of BCUHB. Let me say that again;

SEVEN YEARS AGO…

However professional and detailed that inspection was, it was seven years ago. Bryn Beryl is an isolated community hospital dealing with many vulnerable dementia patients. This is a known set of risk factors and although their own inspection showed many serious problems - HIW appeared to be content with a period between visits of at least seven years.

The 2008 HIW Report identified the same issues that the CHC identified in the Summer of 2014 – yet SEVEN YEARS LATER they have still not undertaken a follow up visit. HIW relied on an exchange of letters rather than an actual inspection to check that improvement to patient care had been carried out. By contrast, the CHC lay members did a follow up within weeks and then kept following up using BugWatch and CareWatch. We will also do our FoodWatch survey in the near future. Rest assured that we will visit Bryn Beryl very frequently until we see permanent improvements.

The BCUHB Annual Quality Statement for 2014/5 that says;

“During 2014 -2015 Healthcare Inspectorate Wales undertook a total of 8 Dignity and Essential Care Inspections across the range of ours services including our main hospitals, community settings and Mental Health Services.”

Over the past 3 years there have been many concerns about the quality of care provided by BCUHB and at least five major critical reports. This is the Local Health Board that has caused Welsh Government the most concern and it is the only Welsh Health Board to be placed in Special Measures. Despite this, HIW felt that Betsi Cadwaladr University Health Board warranted only 8 Dignity and Essential Care Inspections in 2014/15. NW CHC felt very differently and CHC Members have given freely of their time in order to monitor the quality of services from a patient perspective.

Page 32 of the same report records that:

“CHC members undertook over 500 assessments during 2014-15”.

There has been criticism that this is “too many”. However, we do not hear that from Ward Managers and Nurses. They welcome our members as it is often the only way they can get problems sorted out. With regard to the idea that 500+ visits is too many, this works out at somewhere around 4 visits per ward per year – certain wards may receive more than this but it will still be in single figures. HIW visiting frequency could be 4 or 5 years or even as long as a decade apart.

The Minister is right to be concerned about spending NHS money on a duplication of inspections but is aware that, in reality, HIW inspections are few and far between?

There are several other proposals in the Green Paper that substantially reduce the powers of CHCs including reducing our role in consultations and removing the power to refer Local Health Boards to the Minister. I will brief you on those changes over the next month. The closing date for comments on the Green Paper is 20th November 2015 and I believe it is essential that everyone responds, including individual members and any local organizations with an interest in maintaining an effective Patient Voice in the NHS.

Let's be in no doubt that if powerful vested health interests in Wales succeed in removing the regulatory and inspection powers of Community Health Council's there will be more care and cleanliness issues but much much less openness and transparency. 500 inspections compared to 8 will be a massive reduction in quality monitoring.Please lobby your AM's to prevent this detrimental change from going ahead and to maintain an effective Patient Voice in the Welsh NHS.

Friday, 24 July 2015

Wrexham Council's efforts to bully the Language Commissioner into accepting their standards and rejecting others.

I then wrote the following letter to the Leader exposing the council's little games:

Dear Editor,

Cllr Hugh Jones's press release, regurgitated without challenge by the Leader, "Welsh Language red tape too expensive" (Leader, July 17) is deserving of critical comment. Communicating with the public in the delivery of services is fundamental to the core business of the council; in fact all of the £227 million budget is used in some way with delivery of services. In order to deliver those services we have to communicate in a language whether it is English, Welsh or bilingually. How Cllr Jones succeeds in disentangling the £700,000 for Welsh is beyond me and does he therefore agree that by a simple process of elimination that it costs £226 million plus to deliver services in English? It just goes to show that his report and article are "utter tosh" and have the sole intention of undermining the role of the Language Commissioner.

He goes on to argue that Wrecsam Council shouldn't provide services in Welsh because of low take up of those services, forgetting of course that by providing inferior services in Welsh like Wrecsam do, so you are forcing customers to use English services. This is called "suppressing demand" by failing to provide an adequate service in Welsh.

Basically, Wrecsam have made no effort for years to improve on their Welsh language services and now the Commissioner and the law have caught up with them and they're now making excuses, whilst at the same time conveniently forgetting that they have known for over 3 years that this day would come. The Commissioner cannot be blamed for Wrecsam Council behaving like ostriches burying their heads in the sand.

Regards,

The Leader eventually published a heavily edited and sanitised version of the above letter, but even that prompted Hugh Jones to write the following defensive response which doesn't answer the points raised in my letter.

Councillor Arfon Jones is wrong in a number of respects (Wrexham Leader 22/07/15) He knows that the truth is that, I do not and have never, argued that Wrexham should not provide services in Welsh, indeed it is the opposite. As a Council we go to significant lengths to support the Welsh Language and Culture. Similarly it is a distortion of the truth to say that “Wrexham has made no efforts for years to improve its Welsh Language services”. This is an unwarranted criticism of our Welsh Language Officer and her team. As a Council we encourage and support and pay for members of staff to attend Welsh Language Courses. In our support for the Stiwt over many years we have encouraged and enabled the provision of a Welsh Cultural Centre. Through our Library and Museum services we promote and encourage Welsh Language and Culture and we have a Welsh Language Scheme that has been approved and inspected by the former Welsh Language Board. At the same time we have increased the provision for Welsh Language in our schools.

It is equally a distortion of the truth to say that the “law have caught up with the local authority” we have not breached and do not intend to breach any law.

In terms of the Standards which the Welsh Language Commissioner is seeking to apply to Wrexham, we have accepted 134 of the 164, the problem lies in the cost of implementing the remaining 30, which has been estimated to be £700,000 each and every year. At a time when the Welsh Government is asking us to cut £45 million from our budget over the next three years, we have a clear choice, Jobs and Services or the Standards.

Cllr Jones avoids explaining which members of staff will lose their jobs, which services will be cut in order to pay for these 30 Standards.

The implementation of 134 standards will hopefully lead to an increase in the numbers using our services which is something that I welcome and encourage. Indeed the Council would adopt all 164 Standards if the Welsh Government provides the funding.

Cllr Jones I know is passionate about Equalities, we need to understand that we serve a Community where several languages are spoken, not only English and Welsh but also Polish and Portuguese for example all of which provide Wrexham with a broad and rich heritage. At a time when we have a policy of reshaping services and protecting the most vulnerable in our Community we have difficult choices to make, in doing so we will fulfil our responsibility to promote and enhance the Welsh language and Culture but we will do so in a way that does not damage our responsibilities to the whole of the County Borough.

The truth is that Wrexham Council provides the Welsh speaking public with an inferior service in Welsh and thereby suppressing the demand and forcing them to use services in English. There is no doubt that Wrexham Council are treating the Welsh language less favourably than English and the Council need to be commission a 'Mystery Shopper' exercise, but they won't because that will show up which argument is correct.

Thursday, 2 July 2015

Parents campaigning for Welsh-medium education in Wrexham have welcomed news that a school is being re-assessed to see whether it can accommodate more children.

There are currently just five spaces available in reception classes across all of Wrexham’s six Welsh-medium schools - and all those are in Ysgol Bodhyfryd in the Hightown area. Parents who have failed to get their children into other schools say they fear siblings will be split up if they’re forced to accept a place in a school some distance from their homes.

There is also concern that schools cannot cope with demand at nursery level - with 20 pupils failing to get a place at Ysgol Bro Alun, Gwersyllt, despite it being a brand-new school.

The campaigners, who this week handed in a 750-word petition to the council demanding it looks urgently at how it will cope with spiralling demand for Welsh-medium education, believe pressure is mounting on the council to act.

Eleri Roberts, of Summerhill, is one of the parents affected and spoke on behalf of Ymgyrchwyr dros Addysg Gymraeg / Campaigners for Welsh Education, a local pressure group:

“We believe the council is re-thinking and re-assessing its previous stance, which is very welcome news. It’s vital that they listen to parents, to AMs, to councillors and the hundreds of people who have signed our petition in the past fortnight asking that they work harder to meet the demand for Welsh-medium education in the county. It’s clear that the Welsh education minister is unhappy with the situation and we do not believe the council is meeting its own Welsh in Education Strategic Plan. That’s why we’ve kept up the pressure - the council has to stop paying lip service to the Welsh language. “We know that there are parents who want their children to go to Welsh-medium schools but know they live too far away to even be considered and opt reluctantly for a local English-medium school. That’s not meeting demand, that’s suppressing the right we should all have to choose properly. These past few weeks and months have been very difficult for parents faced with the dilemma of taking children to two different schools at the same time and then fearing that next year the problem could be even worse as demand increases but the number of places does not.”

She said it was good to hear that Ysgol Bro Alun, which is over-subscribed despite only opening in 2013, was being re-assessed and hoped this would mean meeting demand in the short-term while the council formulated a longer-term plan to expand Welsh-medium education at primary and secondary levels.

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